Practica Medicala最新文献

{"title":"Gestational diabetes: universal or selective screening in pregnancy?","authors":"Carina Ragea, N. Gică, R. Botezatu, G. Peltecu, A. Panaitescu","doi":"10.37897/rjmp.2022.1.2","DOIUrl":"https://doi.org/10.37897/rjmp.2022.1.2","url":null,"abstract":"Gestational diabetes mellitus (GDM) is one of the most frequent complications of pregnancy. Despite international efforts, there is no consensus regarding the optimal method of screening and diagnosis of GDM. Some organizations propose screening only for women with high risk of GDM, while others suggest testing all pregnant women. Furthermore, there are more types of screening and diagnostic tests (one vs. two-step approach) with different glycemic thresholds. The aim of this review is to present and compare the screening and diagnosis guidelines of the most influential organizations. Additionally, this study evaluates the differences between selective and universal screening. The necessity for a consensus and for a single acceptable guideline has been repeatedly highlighted by experts in order to allow uniform clinical practice and to improve perinatal and maternal outcomes.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46822712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Markers associated with an unfavourable outcome in SARS-CoV-2 infection: Insights from a Romanian military hospital","authors":"O. Ionescu, O. Stancu, Mihai-Lucian Ciobîcă, A. Bredicean, Valentina Negrea, Robert Adrian Dumbravă, A. Georgescu, A. Varga","doi":"10.37897/rjmp.2022.1.4","DOIUrl":"https://doi.org/10.37897/rjmp.2022.1.4","url":null,"abstract":"Background and objectives. The use of affordable and simple tools to identify patients with severe forms of COVID-19 is imperative worldwide. The aim of the present study was to identify factors associated with the unfavourable progression of SARS-CoV-2 infection in the Military Emergency Clinical Hospital “Dr. Victor Popescu”, Romania. Materials and methods. Data from 166 patients admitted with a positive SARS-CoV-2 reverse transcription-quantitative PCR test were retrospectively collected. The presence of lung changes on chest X-ray scans was the criterion used to divide the subjects into two groups: patients with no radiological findings (group 1; n=45) and patients with radiological features of pneumonia (group 2; n=121). Results. The mean age (P<0.0001) and body mass index (P=0.0109) were significantly higher in group 2 compared with group 1. Ageusia and headache, as clinical manifestations of COVID-19, were significantly prevalent (P=0.005 and P=0.007, respectively) in group 2; in the same group, cardiovascular risk factors and established cardiovascular disease were highly prevalent. In SARS-CoV-2 patients with radiological lung changes, correlations were identified between neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (P<0.001; CI 95%, 0.137-0.471) and fibrinogen (P=0.009; CI 95%, 0.054-0.406), respectively. Only the platelet-to-lymphocyte ratio (PLR) was identified as a marker of X-ray changes (P=0.029). Within group 2, and for patients with unfavourable disease progression, the NLR were significantly correlated with intensive care unit admission (P<0.0001) and were highly correlated with mortality (P=0.001). Increased lactate dehydrogenase (LDH) values had the same tendency.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43481370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acromegaly without acral anomalies","authors":"M. Carsote, F. Șandru, Diana Elena Rentea, C. Mehedințu, Stefania Zugravu, C. Chiriţă, M. Dumitrașcu","doi":"10.37897/rjmp.2021.4.22","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.22","url":null,"abstract":"Early recognition of a pituitary secretor tumor offers a better prognostic; thus acromegaly might be recognized before the actual clinical picture of acromegaly is detectable. This is a 59-year old, non-smoking female admitted for: post-operatory evaluation of acromegaly. The clinical evaluation is non-specific. One year prior she was diagnosed with acromegaly based on cerebral imaging assessment due to intermittent headache. She was treated with cabergoline a few months before neurosurgery was done; post-operatory panel showed complete remission of acromegaly. Prompt detection of the disease allowed the early intervention with a very good outcome. The remission of GH excess after neurosurgery depends on tumor size and practical experience of the surgeon. The longer time of high growth hormone levels exposure the higher is the risk of cardio-metabolic and oncologic complications.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45513337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key points in reducing transfusion requirements in perioperative period","authors":"M. Tiglis, I. Peride, T. Neagu, A. Niculae, I. Grințescu","doi":"10.37897/rjmp.2021.4.9","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.9","url":null,"abstract":"Surgical intervention can lead to blood loss either through perioperative complications, or through disease severity until surgery. For this reason, mastering the main strategies to improve surgical patients’ hematological status, to reduce transfusion rate, and to correct hemoglobin level represent the state of art in surgical patient management. In the last period, due to COVID-19 pandemic and the blood shortage crisis across hospitals, applying principles meant to reduce blood loss, and therefore the rate of blood transfusion, have become even more important.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46815738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not just weight loss","authors":"F. Șandru, E. Petrova, B. Petrov, Adina E. Draghici, A. Ghemigian, M. Carsote, A. Dumitrașcu, C. Mehedințu, M. Dumitrașcu","doi":"10.37897/rjmp.2021.4.24","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.24","url":null,"abstract":"Renal cancer (RC) – associated increased calcium is rather frequent among cases of kidney neoplasia; it may be the first sign of presentation that allows the detection of the malignancy; typically representing a poor prognostic factor. Weight loss is part of the panel underling hypercalcemia - related signs, but also of the malignancy – associated phenotype. We aim to introduce a male case who was admitted for a clinical picture (including weight loss) correlated with alarming high calcium levels; the biochemistry anomaly was actually a paraneoplastic syndrome due to RC. When admitted as emergency, the assays revealed hypercalcemia of 16.9 mg/dl (normal levels between 8.4 and 10.2 mg/dl) with low PTH (Parathormone) and high CrossLaps as bone turnover marker of resorption. Intravenous contrast computed tomography showed a large left retroperitoneal tumor (involving the kidney and adrenal gland) with iodophil pattern, and post-contrast heterogeneous structure of 8.06/11.09 cm (axial), 10.58/12.16 cm (coronal-reconstruction), 9.12/10.59 cm (sagittal - reconstruction), also associating a mixt structure and micro-calcifications as well as hypodense areas. Whole body bone scintigram did not show metastasis. The calcium levels were controlled under subcutaneous denosumab 60 mg in addition to IV fluids replacement; then the patient was referred to nephrectomy; postoperative confirmation confirmed a clear cell renal cell carcinoma (T4N1Mx). A normalization of calcium and PTH levels was found immediately after surgery. Unintentional weight loss might become a valuable tool in order to assess a routine biochemistry panel that will detect hypercalcemia. Low PTH represents the next step in order to further look for a tumor. Symptomatic control of hypercalcemia in addition to targeted approach of originating tumor are essential to improve the outcome.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42741173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral adrenal hemorrhage","authors":"M. Dumitrașcu, A. Trandafir, E. Petrova, A. Ghemigian, M. Carsote, F. Șandru, C. Mehedințu","doi":"10.37897/rjmp.2021.4.2","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.2","url":null,"abstract":"Bilateral adrenal hemorrhage represents a challenging condition which requires multi-modal intervention. Our aim to systematically review the published cased diagnosed with this condition. The method we used is based on PubMed database research. The papers are published between 2005 and 2020. We included articles that follow the subsections: idiopathic type, hemorrhage in patients with adrenal tumors, in subjects with hematologic diseases, with autoimmune/systemic conditions, in COVID-19 positive patients, in subjects using anticoagulants, respective in pregnant females.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47136629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modalities of renal replacement therapy in acute kidney injury","authors":"I. Peride, M. Tiglis, T. Neagu, A. Nechita, A. Niculae, I. Checherita","doi":"10.37897/rjmp.2021.4.5","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.5","url":null,"abstract":"Impaired renal function artificial support development massively contributed to increased life expectancy and quality of life improvement. The first steps in this direction were made in the beginning of the 1900s, nowadays existing a variety of methods of renal replacement therapies that could be customized to each patient depending on the associated complications and comorbidities. Considering these aspects and that acute kidney injury (AKI) could represent a life-threatening condition, the present review will present different options of renal replacement therapies suitable to be initiated in emergency.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47300425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stem cells role in regenerative medicine","authors":"R. Bohîlțea, E. Neștianu, Vlad Dima, B. Mihai, T. Salmen, T. Georgescu, S. Tudorache, Cristina-Daniela Enache, R. Vlădăreanu","doi":"10.37897/rjmp.2021.4.4","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.4","url":null,"abstract":"Stem cells are precursor cells capable of self-renew and of generating numerous mature cell types. As the field of human embryonic stem cells harvesting has been put under questionable ethic issues, other sources are under investigation and present tremendous potential: tissue specific progenitor stem cells, mesenchymal stem cells, umbilical cord cells, bone marrow stem cells, and induced pluripotent stem cells. Stem cells interest different departments of regenerative medicine as well as conservative wildlife. Stem cells might be a viable option for the treatment of pathologies such as spinal injuries, cardiovascular disease, diabetes, liver injuries or even osteoarthritis. Scientists are looking forward to developing molecules that can activate tissue specific stem cells, promote stem cells to migrate to the side of tissue injury, and promote their differentiation to tissue specific cells, so that many health issues could have an alternative and efficient treatment and or even be cured.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49022136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Particular aspects concerning acromegaly amid pandemic","authors":"M. Carsote, F. Șandru, Diana Elena Rentea, Stefania Zugravu, C. Mehedințu, A. Dumitrașcu, M. Dumitrașcu","doi":"10.37897/rjmp.2021.4.7","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.7","url":null,"abstract":"Acromegaly embraces typical complications of a pituitary tumor as well as GH (growth hormone) and IGF1 (insulin-like growth factor) excess-related cardio-metabolic and oncologic conditions; and associated medical, surgical treatment or even radiotherapy issues. We point out a few particular aspects concerning acromegaly issues amid COVID-19 pandemic. The review includes only full length, English published papers. One of the most important complications of long standing, untreated or un-responsive to therapy acromegaly is related to respiratory and otorhinolaryngology issues like sleep apnea; this becomes an important aspect causing pulmonary complications in patients with active coronavirus infection. In subjects who are not going through a COVID-19 infection, but they had a prior diagnostic of acromegaly, two main aspects of medical and surgical practice were noted: a massive reduction of surgical volume during the first year of pandemic, mostly during peak months of high infection rate in general population and the introduction of tele (digital) health care systems, of different protocols and various platforms mostly depending of medical center, rather than country or even continent related protocols. Associated central adrenal insufficiency requires a particular attention if COVID-19 positive. The data directly targeting the endocrinologists amid pandemic are very limited. ACROCOVID is a 2021 study that was internationally conducted based on a questionnaire that was applied to 84 endocrinologists (67% of them in Europe); 33% of acromegalic individuals had a delay on procedure because of insufficient COVID-19 assays and 54% of them due to inefficient provision for neurosurgery. Secondary diabetes mellitus (with a potential worsening in some patients due to pasireotide LAR) is at high risk for COVID-19 infection; the level of glycated hemoglobin A1c seems a good predictor at onset of infectious disease. Acromegaly might associate osteoporosis; coronavirus infection aggravates bone loss due to oxidative stress, inflammatory status, cytokine release, immobilization, glucocorticoid use. Acromegaly field concerning pandemic changes represents a complex, still ongoing matter involving both patients and multidisciplinary practitioners.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42484154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular mechanisms involved in cerebral ischemic-induced neuronal death","authors":"C. Stocheci, Bogdan Ioan Coculescu, E. Coculescu","doi":"10.37897/rjmp.2021.4.13","DOIUrl":"https://doi.org/10.37897/rjmp.2021.4.13","url":null,"abstract":"The understanding of the cellular, molecular and biochemical processes that take place during the production of brain lesions has increased recently due to numerous studies of microscopy, cellular and molecular biology, performed on both human material and experimentally on a laboratory animal. Although new therapeutic methods have emerged to treat strokes and prevent them, due to the complexity of morpho and pathophysiological processes, the beneficial effects of treatment are still far from satisfactory.","PeriodicalId":55841,"journal":{"name":"Practica Medicala","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43037570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}